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Facing the loss of one or both breasts can be very
traumatic. Every women diagnosed with breast cancer should be given
information about reconstructive options as part of her breast cancer
treatment.
Almost any woman who loses her breast can have it rebuilt through
reconstructive surgery. And discussion about reconstruction can start
immediately after diagnosis.
The decision to undergo breast reconstruction is an intensely personal
one. The decision should be made by the patient, not by treating
physicians. It really is a quality of life issue. And it doesn't matter
how old the patient is or if they're married or single.
There are several surgical approaches to reconstructing a totally or
partially missing breast. The choice of technique depends on age,
health, the state of the remaining tissue, surgical scars, skin
thickness, radiotherapy treatments, the shape and volume of the breast
to be reconstructed and the remaining breast, etc.
Reconstruction may be simple, involving nothing more than the insertion
of an implant, or more complex. In some cases, for instance, it may be
necessary to replace local tissue with tissue from elsewhere in the
body (a flap of skin or of skin and muscle). Step-by-step
reconstruction is another option, for instance to adjust the size of
the other breast, rebuild the nipple and so on.
Flap reconstruction is a more complex procedure than skin expansion.
Scars will be left at both the tissue donor site and at the
reconstructed site, and recovery time is longer than with an implant.
However, when the breast is reconstructed with one's own tissue, the
results are generally more natural and concerns related to implants are
non-existent.
Skin expansion
This common technique combines skin expansion and subsequent insertion
of an implant. Following mastectomy, a balloon expander will be inseted beneath the skin and chest muscle. Through
a tiny valve mechanism buried beneath the skin, he or she will
periodically inject a salt-water solution to gradually fill the
expander over several weeks or months. After the skin over the breast
area has been sufficiently stretched, the expander is removed in a
second operation and a more permanent implant -- either saline or
silicone -- will be inserted. Some expanders are designed to be left in
place as the final implant. The nipple and dark skin surrounding it --
called the areola -- are reconstructed in a subsequent procedure.
Flap reconstruction
An alternative approach to implant reconstruction involves creation of
a skin flap using tissue taken from other parts of the body, such as
the abdomen, back or buttocks. In one type of flap surgery, the tissue
remains attached to its original site, retaining its blood supply. The
flap, consisting of skin, fat and muscle with its blood supply, are
tunneled beneath the skin to the chest, creating a pocket for an
implant or, in some cases, creating the breast mound itself without
need for an implant.
Another flap technique uses tissue that is surgically removed from the
abdomen, thighs or buttocks and then transplanted to the chest by
reconnecting the blood vessels to new ones in that region.
Recovery times for both procedures range from six months to one year,
or longer, depending on individual circumstances.
Not all women are good candidates for breast reconstruction. Women who
have had a mastectomy or Lumpectomy with radiation are typically not
strong candidates for skin expansion reconstruction. Radiation changes
the characteristics of skin tissue, causing a variety of complications
ranging from excessive scar tissue development, to blood supply and
overall healing problems. While radiation does present some difficult
challenges, it doesn't automatically rule out the possibility of
reconstruction. While each circumstance is different, if there is
enough good tissue to work with, reconstruction remains a viable option
for most women.
Patients that are emotionally unstable should probably postpone
reconstruction. Coping with the reality of breast cancer is an
extremely overwhelming process. If a woman cannot understand the risks
and limitations of reconstruction prior to her mastectomy surgery, I
would recommend she wait.
Managing Misconceptions
Most misconceptions regarding breast cancer reconstructionare
caused by a lack of information. Common misconceptions include having
to wait up to one year to safely undergo reconstruction, reconstruction
makes it difficult to identify cancer if it recurs, and reconstruction
interferes with cancer treatments, such as chemotherapy. All are wrong
on all counts.
Reconstruction can take place immediately following mastectomy with
little complication. In the case of implants, reconstruction may take
longer if the patient has to undergo chemotherapy, but otherwise
doesn't interfere with the process.
Managing Expectations
It is important to remember that the goal of reconstruction is
improvement, not perfection. Be sure to discuss your expectations
candidly with your plastic surgeon, and expect nothing less than total
honesty from him or her in return. To ensure reconstructive surgery has
the desired outcome, breast symmetry procedures – surgery to the other
breast -- is usually also part of the reconstructive process. Symmetry
procedures either reduce, lift or reshape the
remaining breast to ensure a better match to the reconstructed breast.
Symmetry procedures can be an ongoing process, with periodic
adjustments necessary to correct the affects
of the aging process.
The information on this web site is only intended as an
introduction to this procedure and should not be used to determine
whether you will have the procedure performed nor as a guarantee of the
result.
The best method of determining your personal options is to schedule a
personal consultation with Dr. Makki. He will be able to answer
specific questions related to your situation.
Please don't hesitate to call for any questions that you might have
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